Electroconvulsive therapy, formerly known as a electroshock therapy, is an effective way to treat symptoms of severe mental illness, but it is understandably very controversial. In the 1950s, ECT was forced upon real-life psychiatric patients and used as a ‘treatment’ for homosexuality. In pop culture, it was used as a form of punishment in One Flew Over the Cuckoo’s Nest, and it constituted a perverse experiment in Stranger Things. But ECT has come a long way, say doctors. According to a paper released Wednesday, it’s now safe, effective, and the logical choice for people whose depression is resistant to treatment with psychotherapy or medication.

With this in mind, the University of Michigan researchers behind the JAMA Psychiatry paper assessed the cost-effectiveness of ECT for patients with treatment-resistant depression, an illness that is usually treated with expensive drugs and psychotherapy. Using a mathematical model that simulated a patient receiving ECT for four years, they determined that ECT not only makes financial sense but also enables patients to spend less time dealing with the symptoms of their depression.

“Electroconvulsive therapy may be an effective and cost-effective treatment for treatment-resistant depression and should be considered after failure of two or more lines of pharmacotherapy and/or psychotherapy,” the researchers write.

The truth is that ECT can effectively treat depression as well as severe mania or dementia but that nobody is sure how it works. During ECT, small electric currents, designed to intentionally trigger a brief seizure are passed through the brain. This is thought to cause changes in the brain chemistry and reset brain function. Paula Bolton, M.S., the program director of McClean Hospital’s Psychiatric Neurotherapeutics Program describes the treatment as “like when you reboot your computer when something has gone awry” but asserts that “although there are a lot of theories, no one is really quite sure why it works.” The new study is based on the assumption that ECT works and can be used as a cost-effective treatment.

ECT
The use of ECT in 1957 was quite different.

Using ECT as the third course of action to treat depression, the team found, would “cost an estimated 54,000 per quality-adjusted life-year gained” and “over four years, this would reduce time with uncontrolled depression from 50 percent to 34 percent of life-years.”

This may still seem expensive, but the study’s authors argue that ECT is overall more effective. With ECT, 50 to 60 percent of patients on average achieve rapid remission of depression, while only about 10 to 40 percent of patients who use pharmacotherapy or psychotherapy have the same results, the research indicates. ECT is also associated with decreased psychiatric hospitalization rates and reduced long-term risks of suicides — benefits that earned it modern-day fans like Carrie Fisher.

Fisher, who was one of the few public advocates of ECT, described how it helped treat her depression in her 2011 book Shockaholic. As she told Oprah in 2011: “They put you to sleep. They give you a medication so there are no more convulsions or anything … It’s over very quickly and you go home and take a nap.”

Carrie Fisher
Actress Carrie Fisher advocated for ECT as her best form of treatment.

In its early days, ECT did cause convulsions, but it has come a long way. Today, ECT is done under general anesthesia and is often done on an outpatient basis. In a typical run, patients receive the treatment thrice weekly for two to four weeks, with each procedure taking about 10 to 15 minutes. Now, patients receive a muscle relaxant, and they don’t don’t feel the electrical stimulus or the controlled seizures. A possible side effect is some memory loss, experts at Mount Sinai Hospital in New York say it is “one of the safest procedures performed under general anesthesia” and describe it as a “standard clinical treatment that has been extensively studied, significantly refined, and used for millions of people worldwide.”

These refinements — and the fact that present-day patients are choosing to use it for the illnesses it’s meant to treat — set modern ECT apart from the nightmare scenarios of mid 20th-century wards, when it was still known as electroshock therapy. This new study adds to its credibility while acknowledging its practicality: If ECT is the most cost-effective choice, then medical insurance needs to plan on incorporating it.